|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
IP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.20 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Blue Shield of California EPN |
$3,020.30
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,154.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.20
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,135.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2,085.93
|
| Rate for Payer: United Healthcare HMO Rider |
$2,040.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,866.48
|
|
|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
905352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,979.60 |
| Max. Negotiated Rate |
$5,090.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,110.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,738.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,341.56
|
| Rate for Payer: Blue Distinction Transplant |
$3,393.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,242.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,076.86
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,524.80
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Media |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,090.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,242.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,979.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,772.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,894.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,318.96
|
| Rate for Payer: Multiplan Commercial |
$4,242.00
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,262.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,828.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,828.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,828.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,828.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Blue Shield of California EPN |
$145.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.71
|
| Rate for Payer: United Healthcare All Other HMO |
$100.31
|
| Rate for Payer: United Healthcare HMO Rider |
$98.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.76
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.70
|
| Rate for Payer: Blue Distinction Transplant |
$163.20
|
| Rate for Payer: Blue Shield of California Commercial |
$204.00
|
| Rate for Payer: Blue Shield of California EPN |
$147.97
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Media |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$204.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$95.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.52
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Riverside University Health System MISP |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$136.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Blue Shield of California EPN |
$379.67
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.47
|
| Rate for Payer: United Healthcare All Other HMO |
$262.22
|
| Rate for Payer: United Healthcare HMO Rider |
$256.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.63
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$420.06
|
| Rate for Payer: Blue Distinction Transplant |
$426.60
|
| Rate for Payer: Blue Shield of California Commercial |
$533.25
|
| Rate for Payer: Blue Shield of California EPN |
$386.78
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Media |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$533.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.51
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Riverside University Health System MISP |
$284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.50
|
| Rate for Payer: United Healthcare All Other HMO |
$355.50
|
| Rate for Payer: United Healthcare HMO Rider |
$355.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$255.51 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$684.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$602.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.96
|
| Rate for Payer: Blue Distinction Transplant |
$746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$933.00
|
| Rate for Payer: Blue Shield of California EPN |
$676.74
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Media |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$435.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.04
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Riverside University Health System MISP |
$497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$622.00
|
| Rate for Payer: United Healthcare All Other HMO |
$622.00
|
| Rate for Payer: United Healthcare HMO Rider |
$622.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$622.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Blue Shield of California EPN |
$664.30
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.73
|
| Rate for Payer: United Healthcare All Other HMO |
$458.79
|
| Rate for Payer: United Healthcare HMO Rider |
$448.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$410.52
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Blue Shield of California EPN |
$372.73
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.56
|
| Rate for Payer: United Healthcare All Other HMO |
$257.42
|
| Rate for Payer: United Healthcare HMO Rider |
$251.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.34
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$337.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.38
|
| Rate for Payer: Blue Distinction Transplant |
$418.80
|
| Rate for Payer: Blue Shield of California Commercial |
$523.50
|
| Rate for Payer: Blue Shield of California EPN |
$379.71
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Media |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$523.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.00
|
| Rate for Payer: United Healthcare All Other HMO |
$349.00
|
| Rate for Payer: United Healthcare HMO Rider |
$349.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Blue Shield of California EPN |
$512.11
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.12
|
| Rate for Payer: United Healthcare All Other HMO |
$353.68
|
| Rate for Payer: United Healthcare HMO Rider |
$346.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.47
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.53 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$464.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$566.58
|
| Rate for Payer: Blue Distinction Transplant |
$575.40
|
| Rate for Payer: Blue Shield of California Commercial |
$719.25
|
| Rate for Payer: Blue Shield of California EPN |
$521.70
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Media |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$719.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$335.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Riverside University Health System MISP |
$383.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$479.50
|
| Rate for Payer: United Healthcare All Other HMO |
$479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$479.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$479.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,599.56 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,250.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,263.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,862.59
|
| Rate for Payer: Blue Distinction Transplant |
$9,000.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11,250.75
|
| Rate for Payer: Blue Shield of California EPN |
$8,160.54
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Media |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,250.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,250.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,599.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.41
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,500.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,500.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,500.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Blue Shield of California EPN |
$8,010.53
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.20
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,664.38
|
| Rate for Payer: United Healthcare All Other HMO |
$5,532.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5,412.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,950.33
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,714.32 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,379.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,735.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,778.61
|
| Rate for Payer: Blue Distinction Transplant |
$5,868.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,335.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,320.86
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Media |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,335.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,423.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,010.21
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,912.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,890.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,890.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,890.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,890.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Blue Shield of California EPN |
$5,223.05
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.20
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,693.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,607.23
|
| Rate for Payer: United Healthcare HMO Rider |
$3,528.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,227.73
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,264.00 |
| Max. Negotiated Rate |
$5,688.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,374.88
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,056.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,688.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,264.00
|
| Rate for Payer: Multiplan Commercial |
$4,740.00
|
| Rate for Payer: Networks By Design Commercial |
$3,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,386.43
|
| Rate for Payer: United Healthcare All Other HMO |
$2,330.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2,280.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,085.60
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,212.00 |
| Max. Negotiated Rate |
$5,688.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,476.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,476.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,060.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,733.86
|
| Rate for Payer: Blue Distinction Transplant |
$3,792.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,740.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,438.08
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,056.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Dignity Health Media |
$5,372.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,688.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,740.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,212.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,591.20
|
| Rate for Payer: Multiplan Commercial |
$4,740.00
|
| Rate for Payer: Networks By Design Commercial |
$3,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,528.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,160.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,160.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,160.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,372.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,372.00
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Blue Shield of California EPN |
$658.96
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$465.96
|
| Rate for Payer: United Healthcare All Other HMO |
$455.10
|
| Rate for Payer: United Healthcare HMO Rider |
$445.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.22
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$431.90 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$729.05
|
| Rate for Payer: Blue Distinction Transplant |
$740.40
|
| Rate for Payer: Blue Shield of California Commercial |
$925.50
|
| Rate for Payer: Blue Shield of California EPN |
$671.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Media |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$925.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Riverside University Health System MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$617.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$146.32 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,025.63
|
| Rate for Payer: Blue Distinction Transplant |
$1,041.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,072.85
|
| Rate for Payer: Blue Shield of California EPN |
$843.70
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,388.80
|
| Rate for Payer: Cigna of CA HMO |
$1,111.04
|
| Rate for Payer: Cigna of CA PPO |
$1,284.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,475.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,041.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,562.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,302.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,157.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,302.00
|
| Rate for Payer: Networks By Design Commercial |
$1,128.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,475.60
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,041.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,041.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$694.40
|
| Rate for Payer: Galaxy Health WC |
$1,475.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,041.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,562.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,157.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$347.20
|
| Rate for Payer: Multiplan Commercial |
$1,302.00
|
| Rate for Payer: Networks By Design Commercial |
$1,128.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,475.60
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,711.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$542.20 |
| Max. Negotiated Rate |
$2,439.90 |
| Rate for Payer: Cash Price |
$1,219.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,168.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,084.40
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,439.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,032.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.20
|
| Rate for Payer: Multiplan Commercial |
$2,033.25
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,711.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$2,439.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$731.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,601.66
|
| Rate for Payer: Blue Distinction Transplant |
$1,626.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,675.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,317.55
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,219.95
|
| Rate for Payer: Cash Price |
$1,219.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,168.80
|
| Rate for Payer: Cigna of CA HMO |
$1,735.04
|
| Rate for Payer: Cigna of CA PPO |
$2,006.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,304.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,626.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,439.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,033.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,808.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$542.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,033.25
|
| Rate for Payer: Networks By Design Commercial |
$1,762.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,304.35
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,626.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,626.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
IP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$175.33 |
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Central Health Plan Commercial |
$155.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.96
|
| Rate for Payer: Multiplan Commercial |
$146.11
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
|
